Food additive perceptions and practices among young adults in four arab countries

• Food label reading is linked to lower risk perception across four Arab countries • Oman showed highest food additive risk perception; Egypt showed the lowest • Healthcare professionals showed disconnect between knowledge and behavior • Risk perception strongly predicted protective food purchasing practices • Country-level factors outweighed individual demographics in shaping attitudes This study aimed to assess consumer perceptions, purchasing behaviors, and consumption patterns related to food additives (FAs) across four Arab countries: Egypt, Jordan, Lebanon, and Oman. A cross-sectional online survey was conducted using a snowball sampling method, yielding 2,351 participants: Egypt (n=1181), Jordan (n=414), Lebanon (n=342), and Oman (n=414). Statistical analyses included exploratory and confirmatory factor analyses to validate scale structure, multi-group analysis to assess measurement invariance, and descriptive, bivariate, and multivariable methods to examine perceptions and practices. Risk perception was strongly correlated with better practice (r = 0.76, p <0.001) and weakly with age (r = 0.09, p <0.001). Better practice also showed a weak association with older age (r = 0.10, p <0.001). In regression analysis, lower risk perception was significantly associated with being Egyptian (β = -4.88) and reading food labels (β = -0.55), while higher perception was associated with being Omani (β = 2.19), a nutritionist (β = 1.90), a healthcare professional (β = 0.66), having food allergies (β = 1.53), and older age (β = 0.03). Better practice was predicted by being Omani (β = 1.04), having food allergies (β = 0.65), and higher risk perception (β = 0.78), while being Egyptian (β = -2.17) or a healthcare professional (β = -0.43) were associated with poorer practice. Findings reveal cross-country differences in FA perceptions and practices, emphasizing the need for culturally tailored food safety policies and communication strategies. Further research should explore underlying influences and evaluate targeted educational interventions.